Original ArticleEtiology of Chylothorax in 203 Patients
Section snippets
Patients and Methods
All patients with chylothorax seen at the Mayo Clinic in Rochester, Minn, over a 21-year period, from January 1, 1980, to December 31, 2000, were identified by a computer-assisted search of medical records. The presence of a chylothorax was defined by 1 or more of the following inclusion criteria: (1) a pleural fluid triglyceride level of 110 mg/dL or greater, (2) the presence of chylomicrons in the pleural effusion, or (3) a chylous leak into the pleural cavity documented on lymphangiography
Results
The study included 203 patients, 111 males and 92 females, with a median age of 54.5 years (range, 21 weeks’ gestation [thoracentesis performed in utero] to 93 years) (Table 1). Presenting symptoms were documented in 173 patients. Dyspnea was the most common symptom and was present in 98 patients (56.6%). At initial presentation, 64 (37.0%) of the 173 patients had no respiratory symptoms. Two patients (1.2%) reported chyloptysis. The median duration of symptoms before diagnosis was 7.5 weeks
Discussion
Chylothorax can occur in various clinical settings and arise from diverse causes. Tumor has been the most common cause in most case series and was responsible for approximately one half of cases.2 The primary tumor itself or metastatic disease can extrinsically compress or directly invade the thoracic duct. Chylous leakage can result from either a rupture of the duct secondary to back pressure or direct tumor invasion of the duct.2 Traditionally, lymphoma accounted for approximately three
Conclusions
We have shown that chylothorax can be attributable to numerous etiologies, but the percentage of postoperative chylous effusion has increased relative to previous series. Although malignancy still plays a major etiologic role and various nonmalignant etiologies exist, the development and growth of cardiothoracic surgical procedures at our tertiary referral center may have resulted in the number of surgery-related causes (nearly 50%) surpassing the number of malignant causes (16.7%) of
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Dr Doerr is now with St. Luke's Episcopal Hospital, Baylor College of Medicine Affiliated Hospitals, Houston, Tex